Feasibility of endoscopic resection in early gastric cancer with lymphovascular invasion.

87 Background: Lymphovascular invasion (LVI) is associated with the risk of lymph node metastasis (LNM) and poor survival in gastric cancer patients. However, it is unclear whether LVI is a noncurative criteria component in all patients. We evaluated the risk factors of LNM in LVI-positive early gastric cancer (EGC) patients and identified a subgroup with a negligible LNM risk to assess the feasibility of endoscopic resection in these patients. Methods: The clinicopathologic and survival data of patients undergoing surgery for gastric cancer were reviewed; LVI-positive EGC patients were selected. Logistic regression analysis was used to test the associations of potential risk factors with LNM; Kaplan-Meier analysis was used to compare survival curves. Results: LVI was detected in 1,243 (15.5%) patients. In the multivariate logistic analysis, larger tumor size (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.16-1.31; P < 0.001), presence of ulcer (OR, 1.80; 95% CI, 1.15-2.82, P = 0.010), undifferentiated histology (OR, 1.64; 95% CI, 1.25-2.16; P < 0.001), submucosal invasion (OR, 2.28, 95% CI, 1.38-3.76, P = 0.001), middle (OR, 2.12; 95% CI, 1.26-3.55, P = 0.004) or lower third location (OR, 2.28; 95% CI, 1.32-3.60, P = 0.002), and younger age (OR, 0.98; 95% CI, 0.97-0.99; P = 0.002) independently predicted LNM in LVI-positive EGC patients. LVI-positive patients fulfilling the absolute endoscopic resection criteria did not have LNM, and there was no significant difference in the overall (P = 0.928) and disease-specific survival (P = 0.821) between these patients and those with LVI-negative EGC. Conclusions: Additional surgery after endoscopic resection might be unnecessary in LVI-positive patients meeting the absolute criteria for endoscopic resection.

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The optimal timing of additional surgery after non-curative endoscopic resection to treat early gastric cancer: long-term follow-up study

Scientific Reports ◽

10.1038/s41598-019-54778-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Jae Hwang Cha ◽

Jie-Hyun Kim ◽

Hyoung-Il Kim ◽

Da Hyun Jung ◽

Jae Jun Park ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Resection ◽

Oncological Outcomes ◽

Additional Surgery ◽

Significant Difference ◽

Long Term Follow Up ◽

Group B

AbstractPatients with early gastric cancer (EGC) who undergo non-curative endoscopic resection (ER) require additional surgery. The aim of the study was to validate surgical and oncological outcomes according to the timing of additional surgery after non-curative endoscopic resection. We retrospectively analyzed long-term follow-up data on the 302 patients enrolled between January 2007 and December 2014. We validated our earlier suggestion that the optimal time interval from non-curative ER to additional surgery was 29 days. All patients were divided into two groups by reference to time intervals from ER to additional surgery of ≤29days (n = 133; group A) and >29 days (n = 169; group B). The median follow-up duration was 41.98 ± 21.23 months. As in our previous study, group B exhibited better surgical outcomes. A total of 10 patients developed locoregional or distant recurrences during the follow-up period, but no significant difference was evident between the two groups. Interestingly, the survival rate was better in group B. Group B (>29 days) exhibited better surgical and oncological outcomes. Thus, additional gastrectomy after non-curative ER should be delayed for 1 month to ensure optimal surgical and oncological outcomes.

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Long-term outcomes of endoscopic resection followed by additional surgery after non-curative resection in undifferentiated-type early gastric cancer: a nationwide multi-center study

Surgical Endoscopy ◽

10.1007/s00464-021-08464-4 ◽

2021 ◽

Author(s):

Jie-Hyun Kim ◽

Young-Il Kim ◽

Ji Yong Ahn ◽

Woon Geon Shin ◽

Hyo-Joon Yang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Resection ◽

Curative Resection ◽

Long Term Outcomes ◽

Additional Surgery ◽

Undifferentiated Type ◽

Multi Center Study ◽

Center Study

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Su1390 FEASIBILITY OF ENDOSCOPIC RESECTION IN EARLY GASTRIC CANCER WITH LYMPHOVASCULAR INVASION: RESULTS FROM LARGE-SCALE SURGICAL DATABASE

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.517 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB359

Author(s):

Jeung Hui Pyo ◽

Hyuk Lee ◽

Ji Eun Na ◽

Ji Eun Kim ◽

Yang Won Min ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Resection ◽

Large Scale ◽

Lymphovascular Invasion

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Comparing the Risk Factors Influencing Diagnostic Discrepancy of Early Gastric Cancer Based on Expanded Indication of Endoscopic Resection

Gastroenterology ◽

10.1016/s0016-5085(17)31151-4 ◽

2017 ◽

Vol 152 (5) ◽

pp. S255

Author(s):

Seol So ◽

Hwoon-Yong Jung ◽

Hee Kyong Na ◽

Ji Yong Ahn ◽

Kee Wook Jung ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Resection ◽

Factors Influencing

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Histology as a Prognostic Factor in Early Gastric Cancer

Tumori Journal ◽

10.1177/030089169207800307 ◽

1992 ◽

Vol 78 (3) ◽

pp. 181-184

Author(s):

Massimo Ferrari ◽

Enrico Ghislandi ◽

Giuseppe Landonio ◽

Margherita Majno ◽

Tiziano Porretta ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Early Gastric Cancer ◽

Lymph Node Involvement ◽

Depth Of Invasion ◽

Undifferentiated Histology ◽

Node Involvement

Of 431 patients with gastric cancer observed in our Istitution, 23 (5.3 %) had early gastric cancer (EGC). Macroscopic presentation, histology, depth of invasion, and lymph node involvement were evaluated in all the cases. All patients underwent surgery and an intensive follow-up was performed. Five of the 23 patients progressed, and the risk factors were examined. Histology seemed to be the main prognostic factor in our study, since intestinal type of EGC was associated to a significantly better prognosis. Total gastrectomy is indicated in the proximal localization of EGC, and should perhaps be performed also in cases presenting undifferentiated histology.

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Preoperative predictors of beyond endoscopic submucosal dissection indication or lymphovascular invasion in endoscopic resection for early gastric cancer

Surgical Endoscopy ◽

10.1007/s00464-017-6009-8 ◽

2017 ◽

Vol 32 (6) ◽

pp. 2948-2957 ◽

Cited By ~ 5

Author(s):

Su Jin Kim ◽

Cheol Woong Choi ◽

Dae Hwan Kang ◽

Hyung Wook Kim ◽

Su Bum Park ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Endoscopic Resection ◽

Lymphovascular Invasion ◽

Submucosal Dissection ◽

Preoperative Predictors

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Should Elderly Patients Undergo Additional Surgery After Non-Curative Endoscopic Resection for Early Gastric Cancer? Long-Term Comparative Outcomes

The American Journal of Gastroenterology ◽

10.1038/ajg.2011.49 ◽

2011 ◽

Vol 106 (6) ◽

pp. 1064-1069 ◽

Cited By ~ 68

Author(s):

Chika Kusano ◽

Motoki Iwasaki ◽

Tonya Kaltenbach ◽

Abby Conlin ◽

Ichiro Oda ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Elderly Patients ◽

Endoscopic Resection ◽

Additional Surgery

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Long-Term Outcomes of Additional Surgery After Noncurative Endoscopic Resection in Patients with Early Gastric Cancer: A Meta-Analysis

10.21203/rs.3.rs-679042/v1 ◽

2021 ◽

Author(s):

Jian Jiao ◽

Han Li ◽

Liang Shang ◽

Hao Wu ◽

Ronghua Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Resection ◽

Meta Analysis ◽

Long Term Results ◽

Good Survival ◽

Observation Group ◽

Surgery Group ◽

Additional Surgery

Abstract BackgroundThe influence of additional surgery on the prognosis of early gastric cancer who underwent noncurative endoscopic resection was controversial. Different results were observed in different studies. Therefore, this meta-analysis was conducted to evaluate whether additional surgery could produce survival benefits for these patients.MethodsA systematic search was conducted in the PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure and Wanfang databases for relevant articles published until 31 March 2021 to investigate the differences in long-term results between the additional surgery group and the observation group. ResultsSixteen studies including 3877 patients were included in this meta-analysis. The results had shown that the surgery group were younger and more male, higher undifferentiated type, higher rate of SM2, lymphatic and vascular invasion, lower recurrence and metastasis than the observation group. Good survival benefits were observed in additional surgery group with obvious significant differences in the 5-year OS, 5-year DSS and 5-year DFS. Similar results were obtained in the subgroup analysis, such as elderly patients (aged ≥70 years) in 5-year OS. ConclusionThis meta-analysis illustrated that significant survival benefits, including 5-year OS, 5-year DSS and 5-year DFS, could be obtained with additional gastrectomy in patients with EGC after noncurative ER, and patients ≥70 years could also benefit from surgery.

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Predictive factors of residual tumor for the patients with non-curative resection after endoscopic submucosal dissection for early gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.32 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 32-32

Author(s):

Hideki Sunagawa ◽

Takahiro Kinoshita ◽

Akio Kaito ◽

Kazuhiro Kaneko

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Predictive Factors ◽

Odds Ratio ◽

Lymphovascular Invasion ◽

Residual Tumor ◽

Additional Surgery ◽

Additional Gastrectomy

32 Background: Endoscopic submucosal dissection (ESD) is commonly performed for the patients who diagnosed with early gastric cancer. Although additional gastrectomy is recommended for the patients with non-curative ESD in the points of potential risk of residual tumor, many cases have neither lymph node (LN) metastasis nor local residual tumor in surgical specimens. Clinically, it can be difficult to decide whether to perform additional surgery according to patients’ conditions. This study aimed to analyze the clinicopathological features of patients who underwent additional gastrectomy as well as to detect the predictive factors for residual tumor after non-curative ESD. Methods: The patients who underwent additional gastrectomy after non-curative ESD in our institution from January 2005 to August 2016 were retrospectively reviewed. The incidence rates of LN metastasis or local residual tumor were calculated, and furthermore the predictive factors for these outcomes were estimated. Results: 211 patients were enrolled in this study. Pathological examination after additional surgery revealed LN metastasis in 18 patients (8.5%) and local residual tumor in 26 patients (12.3%). Multivariable analysis revealed that lymphatic invasion ( p< 0.0001, odds ratio = 15.6), vascular invasion ( p= 0.042, odds ratio = 3.92) and macroscopic findings (flat/elevated type) ( p= 0.03, odds ratio = 3.53) are predictors for lymph node metastasis. All of the patients without LN metastasis revealed no lymphovascular invasion. Positive vertical margin ( p= 0.0045, odds ratio = 4.17) and horizontal margin ( p= 0.0002, odds ratio = 6.6) were predictors for local residual tumor. Conclusions: The risk of residual tumor can be estimated based on histopathology of ESD. Patients without lymphovascular invasion appear to be a low risk subpopulation for LN metastasis.

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